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section Studies
Microangiopathy IN Diabetes(MIND) : 2024-01, 2027-06
Capillary dysfunction in Sepsis(CapriS) : 2024-01, 2028-06
SCAPIS2Spectrum - Microcirculation substudy : 2024-03, 2029-01
section Conferences
European Society on Microcirculation :milestone 2025-05, 2025-06
ISICEM :milestone 2026-03, 2026-04
European Society on Microcirculation :milestone 2027-04, 2027-05
section Journal clubs
IMA-Journal Clubs : 2024-08, 2029-05
section Milestones
Start date :milestone, 2024-08, 2024-08
Half-Time Control :milestone, 2026-08, 2026-08
Dissertation Defense :milestone, crit, 2029-05, 2029-05
Individual study plan
Bedside assessment of Microvascular Dysfunction
Method evaluation in clinical studies
Disposition
- Introduction and Background: Introduction to the topic, research objectives
- Research plan and Methodology: Study designs, methods and analysis
- Timeline and Milestones: Project timeline with key milestones
- Education: Courses, journal clubs, conferences
- Degree outcomes
- Resources and Support: Overview of resources and support
Introduction and Background
Relevance
Introduction and Background
Relevance
Key Areas: Cardiovascular disease, diabetes, heart failure, sepsis
Clinical Implications
Early Detection and Prevention: Monitoring microvascular function helps identify patients at high risk, enabling early intervention and preventive measures.
Disease Progression and Treatment Monitoring: Microvascular assessment provides a window into disease activity, aiding in the evaluation of treatment effectiveness.
Goal-Directed Therapy: Insights into microvascular health support goal-directed therapies, optimizing treatment plans tailored to individual needs.
Introduction and Background
Problem
Current methods
Capillary refill time
Subjectivity, variability, sens/spec, non-quantifiable*
Coronary angiography
Invasive, cumbersome, resource intensive, organ specific
Stress Cardiac MRT
Cumbersome, resource intensive, organ specific
Biomarkers
Analysis time, interpretation, resource intensive
Introduction and Background
Problem
Future methods - what is needed?
Quantitative
Precision and comparison
Non-invasive
Risk and discomfort
Low variability and High sensitivity
Consistency and precision
Rapid and ease of use
Clinical convenience
Organ-agnostic
Systemic dysfunction
Cost-effective
Iterative usage and goal-directed
Research Plan and Methodology
- The CapriS Study, Capillary Dysfunction in Sepsis
- Patients with severe sepsis or septic shock
- Rapid microvascular decompensation
- Patients with severe sepsis or septic shock
- The MIND Study, Microangiopathy in Diabetes
- Patients with type 1 diabetes, with and without clinical microangiopathy
- Chronic microvascular deterioration
- Patients with type 1 diabetes, with and without clinical microangiopathy
- SCAPIS2Spectrum, Microcirculation Substudy
- Patients with high risk of cardiac microangiopathy
- Microangiopathy in different populations
- Microangiopathy in different populations
- Patients with high risk of cardiac microangiopathy
Research Plan and Methodology
Picture of LSCI
Research Plan and Methodology
Picture of curves
Research Plan and Methodology
CapriS, Capillary Dysfunction in Sepsis
Population: 60 patients, >18 yrs with confirmed/suspected infection at ICU/IMCU <12hrs and SBP <90mmHg despite 10 mL/kg cristalloid.
Outcomes: Primary outcome: peak capillary blood cell velocity (pCVB, mm/s). Secondary outcomes: Severity of condition, macrocirculatory parameters, biomarkers.
Research Plan and Methodology
MIND, Microangiopathy in Diabetes
Population: Patients with DM1 at diabetes outpatient clinic at Danderyd Hospital.
Pilot: 20 healthy controls.
Phase 1: 50 patients with severe DM1 complications and 50 healthy controls.
Phase 2: 100 patients with no microangiopathy, 100 patients with mild microangiopathy, 50 with moderate microangiopathy, as classified by microangiopathy score [1].
Intervention: LSCI, blood tests and charts.
Controls: Healthy controls in each cohort.
Outcomes: Thermal regulation, flow regulation
[1]: 10.1177/1479164120928303
Research Plan and Methodology
SCAPIS2Spectrum, Microcirculation Substudy
Population: Substudy to SCAPIS2. 900 in total to be included in 5 arms; O-CAD, ANOCA, HFpEF, HFrEF and diabetes, including corresponding controls from SCAPIS2 cohort.
Intervention: LSCI, biomarkers, and adenosine stress cardiac MRI.
Comparison: Healthy controls
Outcome: Primary outcomes: Flowmotion analysis, post-occlusion hyperemeia, thermal provocations. Secondary outcomes: Biomarkers
Timeline and Milestones
Timeline and Milestones
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section Mandatory courses
Introduction to Doctoral Education at KI : 2024-10, 2024-12
Basic Laboratory Safety : 2024-12, 2025-01
Medical Research Ethics : 2025-01, 2025-02
Introductory course in clinical studies : 2025-02, 2025-03
Basic Course in Medical Statistics : 2025-03, 2025-04
Present your Research! : 2025-10, 2025-11
Quality Assurance of Clinical Research : 2025-10, 2025-11
section Project specific courses
Statistical Methods with R : 2024-09, 2024-12
Programing in Python : 2024-08, 2024-11
Endothelial Cell Function[...] : 2026-02, 2026-03
Intermediate Medical Statistics : 2026-03, 2026-04
Cellular Signalling : 2026-04, 2026-05
section Milestones
Start date :milestone, 2024-08, 2024-08
Half-Time Control :milestone, 2026-08, 2026-08
Dissertation Defense :milestone, crit, 2029-05, 2029-05
Education
- All courses listed here, 20 hp wow
Education
Journal clubs and conferences
- wow so many journal clubs
Degree outcomes
- So many outcomes!
Challanges and Risk Management
- Large Scale Studies
- Participant Scheduling
- Automatic scheduling system
- Data Collection
- Partially automatic data collection and integrity system
- Participant Scheduling
- Data Analysis Phase
- Well-defined analytic aims
- Specific courses
Resources and Support
- Supervisor: Sara Tehrani, MD, PhD, MICU specialist
- Co-Supervisor: Maria Cronhjort, MD, PhD, anesthesiologist and ICU specialist
Discussion and Feedback